COPD Phenotyping: Hyperpolarized Helium-3 Magnetic Resonance Functional Imaging
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1 COPD Phenotyping: Hyperpolarized Helium-3 Magnetic Resonance Functional Imaging M Kirby, HO Coxson, DG McCormack and G Parraga Imaging Research Laboratories, Robarts Research Institute; Departments of Medical Biophysics, Medical Imaging, Medicine, Western University, London, Canada; Department of Radiology, James Hogg Research Centre, University of British Columbia, Vancouver, Canada
2 Acknowledgements and Disclosures Collaborators Jim Lewis MD Aaron Fenster PhD FCCPM Nigel Paterson MD Robin McFadden MD Giles Santyr PhD Roya Etemad-Rezai MD Geoff Maksym PhD (Halifax) Param Nair MD (Hamilton) Jim Martin MD (Montreal) Research Team Amir Owrangi MEng Sarah Svenningsen BMSc Daniel Buchanan MSc Nikhil Kanhere BE Damien Pike BSc Christiane Burton BSc Lindsay Mathew PhD Steven Costella MEng Andrew Wheatley BSc Shayna McKay BSc Sandra Halko CCRC, RPT Trevor Szekeres RTMR
3 What is a COPD Phenotype? Han et. al. AJRCCM (2010): A single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes
4 Hyperpolarized 3 He and 129 Xe MRI 3 He MRI MRI 129 Xe MRI
5 He MRI Phenotypes: Static Ventilation Healthy Young Parraga et. al Ex-Smoker Fain et. al Stage II COPD Parraga et. al Alpha-1 Antitrypsin Van Beek et. al Surrogate measure of airways disease
6 He MRI Phenotypes: Diffusion-Weighted Healthy Elderly Parraga et al. Inv Radiol. (2007) COPD Mathew et al. Acad Radiol. (2008) Surrogate measure of alveolar size/emphsema
7 He MRI Phenotypes: Diffusion-Weighted Quantified ADC distribution: 1) Absolute difference 2) Gradient (in ADC / cm) Surrogate measure of regional gas trapping
8 He MRI Phenotypes: Dynamic Ventilation 0.0s 1.3s 5.8s 10.3s 14.8s 19.3s Marshall et. al. Thorax (2012) Surrogate of indirect or collateral ventilation
9 He MRI: COPD Phenotypes Baseline Disease progression 1 2 yr Follow-up 1. Kirby et. al. Radiology (2010)
10 w22jcdkx 3 He MRI: COPD Phenotypes Pre-AB Disease progression 1 Response to airway bypass (AB) interventions 2 Post-AB 1. Kirby et. al. Radiology (2010) 2. Mathew et. al. Can Respir J. (2012)
11 w22jcdkx 3 He MRI: COPD Phenotypes Pre-Salbutamol Disease progression 1 Response to airway bypass (AB) interventions 2 Post-Salbutamol Response to therapy 3 1. Kirby et. al. Radiology (2010) 2. Mathew et. al. Can Respir J. (2012) 2. Kirby et. al. Radiology (2011)
12 He MRI: COPD Phenotypes Pre-Salbutamol Post-salbutamol p = 0.02 Posterior ADC significantly reduced post-salbutamol (p = 0.02) 3 He MRI measures reductions in regional gas trapping post-salbutamol Kirby et al. JAP (2012)
13 He MRI: COPD Phenotypes FEV 1 = 41% pred VDP = 16% FEV 1 = 47% pred VDP = 29% FEV 1 = 45% pred VDP = 20% FEV 1 = 54% pred VDP = 14% Exacerbation Kirby et. al. JMRI (Under review)
14 He MRI: COPD Phenotypes Kirby et. al. JMRI (Under review)
15 He MRI: COPD Phenotypes FEV 1 = 41% pred VDP = 16% FEV 1 = 47% pred VDP = 29% FEV 1 = 45% pred VDP = 20% FEV 1 = 54% pred VDP = 14% Exacerbation Kirby et. al. JMRI (Under review)
16 He MRI: COPD Phenotypes 3 He MRI measures worsening prior to and improvements following exacerbation before FEV 1 Kirby et. al. JMRI (Under review)
17 He MRI: COPD Phenotypes Evidence for adult lung growth: - 33-year-old woman underwent a right-sided pneumonectomy - acinar microstructure multiple b-value 3 He MRI Radial Dimension: 1.0 Alveolar Depth: Butler et al. NEJM (2012)
18 He MRI: COPD Phenotypes Evidence for adult lung growth: - 48-year-old woman underwent a upper rightsided lobectomy - two b-value 3 He MRI
19 He MRI: New COPD Phenotypes COPDGene: GOLD-Unclassified 1 - normal FEV 1 /FVC, low FEV 1 Non-obstructed emphysema normal FEV 1 /FVC, low D LCO Research Questions: Do ex-smokers with normal spirometry and abnormal D LCO (AD) have other clinically meaningful measurements? How does 3 He MRI relate to these disease attributes? 1. Wan et. al. AJRCCM (2011) 2. Reid et. al. Chest (2002) 3. Chin et. al.. Chest (1998) 4. Corsico et. al. Respir Med Extra (2007)
20 He MRI: New COPD Phenotypes Ex-smoker Normal D LCO Static Ventilation ADC Map homogenous gas distribution, normal 3 He ADC Ex-smoker Abnormal D LCO heterogeneous gas distribution, elevated 3 He ADC GOLD Stage I heterogeneous gas distribution, ventilation defects, elevated 3 He ADC Kirby et al. CHEST (Under review)
21 He MRI: New COPD Phenotypes Normal D LCO (ND) (n=19) Abnormal D LCO (AD) (n=19) Stage I COPD (n=15) Significance of Difference (p) ND-AD AD-COPD 6MWT Distance m (±SD) 430 (99) 341 (95) 417 (41) SGRQ Total Score (±SD) 12 (14)* 29 (21) 25 (17) He MRI Measurements ADC cm 2 /s (±SD) 0.27 (0.03) 0.30 (0.03)* 0.36 (0.08) AD subgroup had significantly worse 6MWD and SGRQ compared with ex-smokers with normal ADC and D LCO
22 He MRI: New COPD Phenotypes Regional Gas Trapping r = p =
23 He MRI: New COPD Phenotypes r = p < r = 0.34 p = 0.02
24 He MRI Phenotypes of COPD 3 He MRI static and dynamic ventilation: Disease progression Exacerbations Response to therapy Indirect pathways/collateral ventilation 3 He MRI ADC: Exacerbations Tissue microstructure
25 London Lung Imaging Research Team
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